ons dagelijks brood: nog steeds voedzaam en gezond? · carbohydrate intake and prevention of...

Ons dagelijks brood:

nog steeds voedzaam en gezond?

Jan Willem van der Kamp

TNO Food and Nutrition , Zeist, the Netherlands

jan-willem.vanderkamp @tno.nl

Inhoud Inleiding - Graan en Brood –wat zit er in? Voedingsonderzoek – en voedingsaanbevelingen Hypes en goeroes Duurzaamheid en eco-efficiency

HEALTH EFFECTS OF CEREAL FIBRE

OVERVIEW PRESENTATION JANUARY 2015

Gabriele Riccardi, MD, FAHA Full Professor of Endocrinology and Metabolic Diseases

Director of the Master Course on Human Nutrition

Federico II University, Naples, Italy

Health benefits of cereal foods and

components in our daily diet - an

overview

School of something FACULTY OF OTHER

Cereal fibre and psychological wellbeing in

young and middle-aged adults

Clare Lawton

Leeds Nutrition & Behaviour Group

School of Psychology

University of Leeds, UK [email protected]

Germ Antioxidants,

vitamin E,

B vitamins

Bran

Dietary fibre,

B vitamins,

trace minerals,

phytochemicals

Enzymes

Endosperm Starch,

Protein

The wheat kernel: classical picture

Cell walls: blue

Protein: red

Starch: black

Testa (1%)

Alkylresorcinols

Aleurone

layer

(6-9%)

Starchy

endosperm

(80-85%)

Starch

& Proteins

• Lipids

• Antioxidants

• Vitamin E

• B vitamins

• Minerals

• Plant sterols

• Enzymes

• Soluble & insoluble dietary fibre (xylans, -glucans)

• Proteins

• Antioxidants (phenolic acids)

• Vitamin E

• B vitamins

• Minerals

• Phytic acid

• Enzymes

Germ

(3%)

• Insoluble dietary fibre (xylans, cellulose, lignin)

• Antioxidants bound to cell walls (phenolic acids)

Crease

Brush

Inner -

and

Outer

pericarp

(4-5%)

Bra

n

THE WHEAT GRAIN KERNEL -UNEVEN DISTRIBUTION OF TARGET COMPONENTS

HE

ALT

H G

RA

IN

Whole grains shall consist of the intact, ground, cracked or flaked kernel after the

removal of inedible parts such as the hull and husk. The principal anatomical

components the starchy endosperm, germ and bran are present in the same relative

proportions as they exist in the intact kernel.

Small losses of components that is, less than 2% of the grain/10% of the bran that

occur through processing methods consistent with safety and quality are allowed.

- The most comprehensive definition of whole grain (WG)

- The only WG defintion published in a peer reviewed journal

Classical definitions don’t address practical issues

HEALTHGRAIN Definition of Wholegrain and follow-up

Health benefits of wholegrain as indicated in large observational studies

are related to current way of > 90 % of flour production:

’modern milling’ with separation of endosperm, bran, germ

Therefore the HG WG Definition accepts separation + recombination both

at the flour mill and by food producers

Production based on Good Manufacturing Principles is required

2% removal of outer part of bran allowed, for ensuring food safety

FOLLOW-UP

Definition used as internal standard by range of major companies

Recombined WG wheat flour - widely used ratio’s: 82% white flour, 15% bran, 3% germ

(’natural ratio’s of individual cultivars show much larger variations , e.g. 9 to 18% bran)

NBC – certification sytem for wholemeal wheat flour now applied by mainstream

suppliers to bakeries in the Netherlands.

Adapted from: Surget, A.; Barron, C., Histologie du grain de blé. Industrie des

Céréales 2005, 145, 3-7.

Hemery, Y.; Rouau, X.; Lullien-Pellerin, V.; Barron, C.; Abecassis, J., Dry processes

to develop wheat fractions and products with enhanced nutritional quality. Journal of

Cereal Science 2007, 46, (3), 327-347

Cereal DF (g/100g)

Tarwe

Spelt

12

11

Haver 11

Gerst 16

Maïs 7

Rogge 15

Rijst 4

Millet 9

Sorghum 6

Teff 8

Pseudo Cereal

Wild rice 6

Amaranth 7

Boekweit 10

Quinoa 7

Data provided from USDA National Nutrient

Database for Standard Reference. Cereal

grains fiber content (available 2013-04-25).

http://ndb.nal.usda.gov/ndb/search/list

Fibre in cereals and location of bioactive

compounds

http://ndb.nal.usda.gov/ndb/search/list

Differences in the contribution of macronutrients from

wheat flour (whole grain vs. white flour) to Guidelines

Daily Amounts (GDA)

Source: National Nutrient Database for Standard Reference (Release 24), ARS, USDA

GDA

Differences in the contribution of micronutrients

from wheat flour (whole grain vs. white flour) to

Daily Reference intake(DRI)

Source: National Nutrient Database for Standard

Reference (Release 24), ARS, USDA

DRI

Voedingsaanbevelingen – Vroeger en nu 1967 Publicatie van Klavertje Vier 1980 Eerste Dietary Guidelines for Americans – update elke 5 jaar 1986 Eerste Richtlijnen Goede Voeding in Nederland. 1996 Publicatie van eerste Actieve Voedingsdriehoek in België

2000-2010 Regelgeving over voedings- en gezondheidsclaims

EU Claims regulation (2006) en implementatie (vanaf 2010) 2015 Nieuwe aanbevelingen in Engeland, V.S. en Nederland _____________________________________________________ Trend: meer specifieke en kwantitatieve aanbevelingen

Dr Samuel Sarphati, Amsterdam 1813 - 1866 1852 Vereeniging van Volksvlijt

1857 Eerste NL Meel en Broodfabriek – goed en goedkoop brood!

Dr Thomas Allinson (1858 -1918) ‘Naturopathy ‘.

Boek: The advantages of wholemeal bread 1892: The Natural Food Company -> Allinson bread

Dr John Harvey Kellogg (1852 – 1943) Breakfast cereals

Corn Flakes Wholegrain and “All-Bran” producten

Geschiedenis - ondernemende artsen!

Voedingsonderzoek – diverse types a) Modelsystemen (b.v. in vitro spijsverteringssysteem) b) Dierproeven c) Onderzoek met proefpersonen (wat is invloed van enkele variabelen?) Interventieonderzoek – veelal twee groepen – enkele weken / maanden Meten van vele ‘biomarkers’ zoals gehalte HDL en LDL cholesterol. d) Cohortonderzoek - voedingsepidemiologie Volgen van grote groepen (~ 100.000 of meer) gedurende vele jaren Doel: Vinden van verbanden: leefstijl, voedingspatroon, ziekte en gezondheid Grote cohortonderzoeken gestart tussen 1980 en 1990 Nu finale resultaten (“over-all mortaliteit” in relatie tot voedingsgewoonten)

d2) Meta-analyse van aantal cohort-onderzoeken

Tang G et al. – Am J Cardiol, 2015

Habitual consumption of whole grain is associated with a lower incidence of Coronary Diseases

Meta-analysis of cohort studies

Dose-response relationship between quintiles of whole grain consumption and Cardiovascular Disease mortality

Wu H et al. – JAMA Intern Med, 2015 Hazard Ratio +- 95% confidence intervals

Grootste effect al bij enkele

sneetjes brood per dag

Habitual whole grain consumption is associated with a lower risk of type 2 diabetes:

meta-analysis of cohort studies

Aune D et al, Eur J Epidemiol, 2013

An inverse dose-response relationship exists between whole grain consumption and the risk of type 2 diabetes:

dose-response meta-analysis of cohort studies


most of the

benefits were

observed up to

an intake of

two servings

per day

Habitual refined grain consumption is not associated with the risk of type 2 diabetes:

meta-analysis of cohort studies


There is no relationship between habitual refined grain consumption and the risk of type 2 diabetes:

dose-response meta-analysis of cohort studies


Habitual whole grain consumption is associated with a lower mortality for cancer with a dose-response relationship

the NIH-AARP Health Study

Huang T et al, BMC Medicine, 2015

DF and colorectal cancer- cereal fibre

appears more effective than other fibres

A high intake of dietary fibre, in particular from cereals, is associated with a

reduced risk of colorectal cancer

Similar results from EPIC as shown by Aune et al.

PLoS One. 2012;7(6):e39361. doi:

10.1371/journal.pone.0039361

Data of 6 pooled studies, incl. 286.125 persons and 10.944 cases of

type 2 diabetes

Associations for bran intake were similar to those for total whole grain

intake

No significant association was observed for germ intake

Two servings of whole grain/day is associated with 21% decrease in

risk of developing type 2 diabetes!

One serving of whole grains corresponds to a ~30g slice of 100%

whole wheat bread (US Department of Agriculture)

Source: PloS Medicine 2007;4(8):e261

Dietary fibre showed significant advantage over placebo in stool

frequency (19%, P<0.05)

No difference in stool consistency, treatment success, laxative use

and painful defecation compared to control

(2012), World J Gastroenterol

Increasing Cereal Fibre Intake Improved

Psychological Wellbeing

References: Lawton, C.; Struthers, L.; Hoyland A.; Myrissa, K.; Dye, L. Effects of increasing dietary fibre on psychological wellbeing. Ann. Nutr. Metab. 2011, 58, 266.

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Overzicht van graan – gezondheid publicaties

http://wholegrainscouncil.org/whole-grains-101/health-studies-on-whole-grains

Voorbeelden voor “Any grains” en “Mortality”

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Graan – gezondheid publicaties



Whole Grains and Cereal Fiber Linked with Longevity

A growing body of research suggests that whole grains may help you live

longer. Boston scientists analyzed data from over 367,000 adults,

those with the highest intake of whole grains had a 17% lower risk of

death from all causes compared to those who ate the least whole grains.

Those eating the most whole grains had a lower risk of several disease-specific

deaths, ranging from 11% for respiratory disease, up to 48% for diabetes.

A high intake of cereal fiber (the fiber from grain foods) was associated with a

19% lower risk of death from all causes, and a 25-34% lower risk of

disease specific deaths.

BMC Medicine. 2015 Mar 4;13:59 (Huang T et al.)

http://www.biomedcentral.com/1741-7015/13/59

http://www.biomedcentral.com/1741-7015/13/59

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Graan – gezondheid publicaties



Fiber in Grains Lowers Mortality Risk

Korean scientists analyzed studies following over 900,000 people to determine

the relationship between fiber intake and mortality.

Those with the highest fiber intake (about 27g/day) had a 23% lower risk

of death than those with the lowest fiber intake (about 15g/day).

However, upon closer inspection, the researchers found that these results were

largely dependent on the foods eaten.

- As fiber from grains increased, mortality significantly decreased.

- A similar, although much weaker, relationship was observed for fiber

from beans and vegetables,

- While no association was observed for fruit fiber.

American Journal of Epidemiology. 2014 Sep 15;180(6):565-73. (Kim Y et al).

http://www.ncbi.nlm.nih.gov/pubmed/25143474

http://www.ncbi.nlm.nih.gov/pubmed/25143474

Dietary Guidelines Issued and updated per country by authoritative body Process description Experts appointed by authoritative body

(Nutritionists, medical doctors, sometimes food spoilage microbiologist)

USA – Dept.’s of Health and Agriculture;

Germany – Nutrition Society; Netherlands – Health Council

Scientific basis: literature searches (e.g. PubMed)

Human studies only – rigorous criteria for inclusion in search

Studies relating diets to key diseases, disorders and mortality

(Heart, blood pressure, type-2 diabetes, cancer, obesity,

(sometimes included: severe mental diseases/ disorders)

Conclusions per type of food and for key components

(fats/oils, proteins, carbohydrates, fibre)

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Rigorous selection of publications taken into account (Example Hauner, 2012)

Key Documents and sources EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA); Scientific

Opinion on Dietary Reference Values for carbohydrates and dietary fibre. EFSA

Journal 2010; 8(3):1462 German Nutrition Society: Hans Hauner et al. Evidence-Based Guidelines

Carbohydrate Intake and Prevention of Nutrition-Related Diseases Ann Nutr Metab

2012;60 England: Scientific Advisory Committee for Nutrition (SACN) Carbohydrates and Health report July 2015 (> 30 MB) 2010 Dietary Guidelines for Americans (Departments of Agriculture and Health) USDA Background document for 2015 Dietary Guidelines for Americans (> 600 pages) Nederland – Gezondheidsraad - Richtlijnen goede voeding 2015 (november 2015)

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Conclusies – Aanbevelingen Nederland – Gezondheidsraad 2015

- Eet dagelijks ten minste 90 g bruin brood, volkorenbrood of

andere volkorenproducten

- Vervang geraffineerde graanproducten door volkorenproducten

Engeland SACN Carbohydrate and health report

- Koolhydraten - ~50% van totale energie

- Vrije suikers(ook vruchtensappen) max. 5% van tot. Energie

- Voedingsvezel – 30g/ dag voor volwassenen, vezels uit groente,

fruit en volkorenproducten

German Nutrition Society – Summary of Evidence Wholegrain products and cereal fibre best associatedwith health benefits

Legend ─ not assessed O possible evidence, no association

↓ possible evidence, risk reducing ↓↓ probable evidence, risk reducing

~ insufficient evidence

Hauner et al. Ann Nutr Metab.

2012;60 Suppl 1:1-58

Evidence level: A (strong evidence)- D (inadequate evidence)

Scientific Statements of Cereal Fibre and Disease

T2D Obesity CVD Hypertension

Cereal Fibre B B/C B D

Mixtures of whole

grains and bran

B B/C B D

Whole grains C C/D C D

Cho et al. Am J Clin Nutr (2103)

The ASN position: Consumption of foods rich in cereal fibre or mixtures of whole

grains and bran is modestly associated with a reduced risk of obesity (B/C), T2D

(B), and CVD (B).

Statement based on current available literature from 1965-2010.

No long-term RCTs (>1y) using cereal fibre was available for disease endpoint.

Recommended dietary fibre consumption at least 25 g/ day. Preference for fibre naturally occurring in foods

Intake Remarks

EFSA (2010) 25 g / day 25 g is adequate for normal laxation in adults.

Diets rich in fibre containing foods at DF intakes ≥ 25g

are associated with additional health benefits

WHO (2003) ≥ 25g / day Total dietary fibre from whole grain cereals, fruit and vegetables

Germany, Austria, Switzerland

(D-A-CH,2008). UK SACN

≥ 30g / day At least 30 grams of dietary fibre daily, especially from whole-

grain products

Netherlands (GR, 2001, 2006) 30-40g / d. 30-40 g dietary fibre via products not enriched with isolated and

purified dietary fibre

Nordic Countries (NNR 2012) 25-35g / d.

USA (IoM, 2005) 25-38g / d. Total fibre from whole grain cereals, fruit and vegetables for

women and men, respectively

USA

(USDA, 2010)

Choosing whole grains that are higher in dietary fibre has

additional health benefits

Unclear if added fiber provides the same health benefits as

naturally occurring sources

Van der Kamp and Lupton 2013

Fibre-rich and wholegrain foods. Cambridge, UK: Woodhead; 2013, pp. 3-24

Remarks on added fibre

examples showing the general opinion

SACN Carbohydrates and Health report 2015 There is evidence to show that particular extracted and isolated fibres have positive effects on blood lipids and colorectal function but due to the smaller evidence base, it is not known whether these components confer the full range of health benefits associated with the consumption of a mix of dietary fibre rich foods. Therefore, it is recommended that fibre intakes should be achieved through a variety of

food sources. USDA 2010:

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Statements van ‘goeroes’ en feiten - 1

Statements o.a. in sociale media

De feiten

Granen worden pas sinds

10.000 jaar gegeten.

De oermens is genetisch

niet aangepast aan

consumptie van granen en

andere zetmeel-houdende

gewassen

Recent archeologisch

onderzoek laat zien dat

zetmeel-houdende gewassen,

waaronder granen al meer dan

100.000 jaar gegeten worden.

Oermensen - Genoomanalyse

Zij hebben veel meer (6)

zetmeel-afbrekende enzymen

dan andere primaten (2)

Fabels en feiten - 2

Moderne tarwe is genetisch

gemodificeerd en bevat

gliadine, een verslavende component van gluten

Moderne tarwe is niet genetisch

gemodificeerd. Tarwe van vroeger en nu bevat evenveel gliadine en glutenine.

Een dieet hoog in

koolhydraten is ongezond.

Hogere eiwitconsumptie is beter.

Dit is in tegenspraak met de officiële

voedingsaanbevelingen .

Voeding hoog in eiwit heeft ook

gezondheidsnadelen.

Van belang is – om ook bij lagere

koolhydraatconsumptie - veel

voedingsvezel (= koolhydraat) te consumeren

Oude tarwesoorten zoals

spelt en speciale granen

zoals quinoa zijn gezonder dan moderne tarwe

De samenstelling van spelt wijkt

nauwelijks af van die van gewone tarwe.

Quinoa bevat vrij veel sporenelementen, maar veel minder vezel dan tarwe

Placebo en Nocebo effect

Mensen die een speciaal dieet volgen – b.v. een laag koolhydraat dieet - of die

geen tarwe meer eten (Djokovic!) zeggen vaak dat ze zich beter voelen. (Maar

Murray stelde: “gluten-free was heel slecht voor me”)

Mogelijke verklaring:

het Nocebo effect -, vergelijkbaar met het Placebo effect.

Placebo-effect voorbeeld: ik consumeer neutrale stof verpakt als medicijn – en ik

voel me beter.

Nocebo voorbeeld – ik eet geen gluten / weinig koolhydraten, dus ik voel me beter.

Fossil grain- 300 milion yrs

found: Geo park Araripe- Brasil

- 1-4 million years: our ancestors in Kenia

consumed a diet composed of plants,

grasses and seeds

www.pnas.org/cgi/doi/10.1073/pnas.1222571110

Nadel et al. Antiquity. Vol. 86, 334, Dec. 2012, Pages 990-1003, PNAS | January 11, 2011 | vol. 108 |

no. 2 | 487

45.000 jaar geleden!

Microdeeltjes van graszaden (tarwe, gerst, rogge) in

tandglazuur bewijzen consumptie in het Neanderthaler dieet:

Evidence for the processing of wild cereal

grains at Ohalo II, a 23 000-year old campsite,

Israel Nadel et al. Antiquity. Vol. 86, 334, Dec. 2012, Pages 990-1003

45.000 years ago! Micro-particles in dental enamel prove consumption of

plants and cooked meals in the Neanderthal diet: dates, vegetables, roots,

wheat, rye and barley

PNAS | January 11, 2011 | vol. 108 | no. 2 | 487

amber

Brood-type en gezondheid

Brood Opmerkingen / relatie tot gezondheid

Boeren-, Oer-, Andes-

brood enz.

Geen relatie tot gezondheid

Donkere kleur Met gebrande mout, - suiker

(kleur puur volkoren: licht bruin/ grijs)

Meergranen % andere granen dan tarwe niet gedefinieerd

Geen relatie tot gezondheid

Spelt- quinoa- maïs-

brood enz.

Niet gezonder dan gewoon brood

% Spelt e.d. ligt niet wettelijk vast

Biologisch Relatie tot graanteelt en kwaliteit van gebruikte

stoffen. Geen bewezen relatie tot gezondheid

Vezelrijk

(dwz > 6% vezel)

Bewezen relatie tot gezondheid met vezels uit

graankorrel (n.b. niet uit tarwestro/ kaf van haver)

Volkoren Bewezen relatie tot gezondheid

De term volkoren is wettelijk gedefinieerd

Evolutie

tarwegroep

Spelt is een

tarwesoort

• !

The food pyramid and the sustainability pyramid

The life cycle assessment of

pasta and red meat

57

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Impact of food production on CO2 emissions

Blonk Consultants,

2015

Product Carbon footprint

kg CO2-eq./kg

Beef 46.7

Cheese, Gouda 9.2

Pork 7.7

Chicken 5.1

Salmon 3.9

Egg 3.3

Herring 2.0

Tomato 1.7

Cashew nuts 1.6

Milk, semi-skimmed 1.2

Crispbread 1.0

Bread, white 1.0

Bread, rye 0.9

Bread, wholemeal 0.9

Carrots 0.7

Potatoes 0.7

Cereal, wholegrain 0.7

Apple 0.5

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Product (ready-to

eat)_

Carbon Footprint

Dry matter (DM) %

CO2 footprint

Per kg DM

kg CO2-eq./kg

kg CO2-eq./kg

Beef 46.7 74,0 (raw) 180

Cheese, Gouda 9.2 39,3 15

Pork 7.7 52,0 16

Chicken 5.1 52,0 11

Salmon 3.9 64,2 11

Egg 3.3 76,2 14

Herring 2.0 65,0 5,7

Tomato 1.7 95,4 37

Cashew nuts 1.6 2,9 1,7

Milk, semi-skimmed 1.2 89,4 11

Crispbread 1.0 6% 1,1

Bread, white 1.0 37.3 1,6

Bread, rye 0.9 46.2 1,7

Bread, wholemeal 0.9 38.8 1,5

Carrots 0.7 90,4 7,3

Potatoes 0.7 78,0 3,2

Cereal, wholegrain 0.7 11,0 0.79

Apple 0.5 85,8 3.52

Food Sustainability

Access to sufficient, nutritious, and safe food is an essential element of food

security for the U.S. population. A sustainable diet ensures this access for

both the current population and future generations. The major findings

regarding sustainable diets were that a diet higher in plant-based foods, such

as vegetables, fruits, whole grains, legumes, nuts, and seeds, and lower in

calories and animal based foods is more health promoting and is associated

with less environmental impact than is the current U.S. diet. This pattern of

eating can be achieved through a variety of dietary patterns, including the

Healthy U.S.-style Pattern, the Healthy Mediterranean-style Pattern, and the

Healthy Vegetarian Pattern.

2015 USDA Scientific report for the Dietary Guidelines for Americans

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Conclusie– geniet van lekker

volkoren- en ander brood